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Monday, 24 March 2014

Maternity care is not just a British right - it's a human right

The right of pregnant migrant women in the UK to access and receive vital maternity care is in jeopardy, as a result of proposed NHS charging policies and the Immigration Bill, currently in the House of Lords. We are working with Maternity Action and the Royal College of Midwives to campaign to ensure that all women have access to the maternity care they need.

Below is a guest post fromMaternity Action,the UK’s leading charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children.

Maternity care is classified as a human right
and as such is protected by the European Convention on Human Rights, which
prohibits all pregnancy-related discrimination, including making it unlawful
for NHS organisations or clinicians to discriminate against pregnant women on
the basis of disability, race, religion, immigration status and national
origin. In line with this, a pregnant woman’s right to receive maternity care
on the NHS is protected in the UK as ‘immediately necessary treatment’, which means
it should not be refused or delayed for any reason.

Under current rules,
women are chargeable for maternity care if they are not ‘ordinarily resident’
in the UK and do not fall within other exempt groups. Women who are chargeable
should receive an invoice for treatment, often early in their pregnancy, but
should not be refused care if they are unable to pay. If a woman does not pay,
the Home Office may be notified and choose to deny subsequent immigration
applications, pending payment of the debt.

Present rules on charging for maternity care
are already complex and confusing, poorly understood by migrant women, and
poorly implemented by trusts and NHS staff. Government research suggests that
NHS trusts have incorrectly classified as many as 30% of the people that were
assessed and so charged people entitled to free care.

Recent government proposals in the
Immigration Bill are very likely to exacerbate the problem pregnant migrant
women already face in accessing maternity care, including in some recent
instances of women being denied care because of their inability to pay, despite
the rules against this. These provisions are part of a broader programme of
changes to migrants’ access to NHS services, proposed in a Department of Health
consultation last year. Among other things, the Bill: introduces a ‘migrant
levy’ on visa applications, whereby an upfront fee will have to be paid to
access healthcare; significantly expands the group of migrants who are
chargeable for NHS care; and, extends charging to aspects of primary and
emergency care. Crucially, and in addition to this, it identifies and pursues
chargeable migrants much more aggressively, including requiring NHS staff to
essentially ‘police’ who is chargeable for care based on their immigration
status.

Charges at the point of care create
additional and unnecessary risks that women will choose not to see a midwife
throughout their pregnancy or may even avoid hospitals altogether and try to
have their baby at home. For those that do see a midwife, many only see a
midwife very late in pregnancy, or try to see a midwife only to be denied
access to care because of their inability to pay. This can prevent midwives
from identifying and treating health conditions early in pregnancy such as,
HIV, Hepatitis, Rubella and Syphilis – leading to significantly worse health
outcomes for vulnerable migrant women and their babies, as well as complex,
costly interventions at a later date. Furthermore, 20% of all maternal deaths
are to women who commenced care later in pregnancy (after 22 weeks), missed
more than four antenatal visits, or had no antenatal care at all.

We know that vulnerable
migrant women already have significantly worse maternal and infant health than
the rest of the population. The National Institute of Health and Care
Excellence recognises this and has issued guidance, which identifies recent
migrants, refugees and asylum seekers as a distinctive risk group and recommends
that care providers take additional measures to promote early engagement with
maternity services. Yet these changes are likely to make it much harder for
vulnerable and at risk women to access maternity care.

Whilst it is true that under these proposals
all pregnant women in the UK will still legally have the right to receive
maternity care, the question remains, in practice will they receive it? Will
they feel confident to access routine and vital antenatal appointments if they
fear doing so will result in costly fees they cannot afford and may be used
against their future visa applications? Will they choose not to endanger their
life and that of their unborn child, by going to hospital when they are in
labour, rather than staying at home, if they fear it will result in
deportation? The reality is vulnerable pregnant migrant women residing in the
UK are a lot less likely to feel empowered or supported to exercise their human
right to maternity care should this legislation, in its current form, become
law.

To learn more about the campaign or to get
involved, such as through writing to your MP, visit the Maternity Action website here or contact Sarah LaPham, Public Affairs and Campaigns
Officer at Maternity Action.